MODALITIES OF MANAGEMENT OF VERNAL KERATOCONJUNCTIVITIS

Autor: Hemalatha A, Sneha N. Hegde, Bajantri Y B, Rajshekar D
Rok vydání: 2015
Předmět:
Zdroj: Journal of Evidence Based Medicine and Healthcare, Vol 2, Iss 13, Pp 2001-2006 (2015)
ISSN: 2349-2570
2349-2562
DOI: 10.18410/jebmh/2015/284
Popis: BACKGROUND: Ocular allergy is a common disorder which can be debilitating for patients and, at times, challenging for physicians to diagnose and treat . Allergic disease affects 30 – 50% of the population . Vernal kerato conjunctivitis has predilection for young age group and the diagnosis is generally based on signs and symptoms of the disease . This study is undertaken to stress upon the importance of clinical manifestations, management and prevent the complications of the disease and those secondary to its long - term medication . AIM OF STUDY: To study the different modalities in management of VKC patients . MATERIALS & METHODS: 74 patients with VKC selected at random, who attended the department of ophthalmology KIMS, Hubli from December 2012 to May 2014 . The relevant details of history and clinical examination of the patients were recorded on a specifically designed Proforma . The type and severity of VKC and its association with corneal involvement was noted . Clinical observation and evaluation of clinical signs and symptoms were performed before and after drug therapy at first visit, weekly interval for 2 weeks and at the end of 3 months . Therapeutic options are many, in most cases topical and chosen on the basis of the severity of the disease . RESULTS: 68/74 (91 . 89%) patients were put on 0 . 1% olopatadine eye drops 2 times a day at 0 visit . Additional treatment such as 0 . 5% ketorolac 4 times a day in 13/68 patients, 0 . 1% bromofenac 2 times a day in 3/68 patients and 0 . 1% Napafenac 2 times a day in 1/68 patient was added along with olopatadine at visit 0 . In 16/68 patients with persistent symptoms with olopatadine alone 0 . 5% ketorolac was added in subsequent visits . 15/68 patients with persistent symptoms received Flurometholone 0 . 1% in the subsequent visits along with 0 . 1% olopatadine . All these patients who received 0 . 5% ketorolac alone or with other drugs responded well . Fallow – up patients using 0 . 1% olopatadine showed that there were no side effects and majority of patients responded well . 29/74 (38 . 18%) patients were treated with topical corticosteroids . 20/74 patients were put on Flurometholone 0 . 1% 4 times a day . 5/20 patients with severe disease were put on Flurometholone at visit 0 and in remaining 15 patients were treated with Flurometholone in the subsequent visits . All patients responded well except for one patient who had giant papillae with mechanical ptosis required surgical management . 8/74 patients were treated with 0 . 2% Lotoprednol etabonate4 times a day in the visit 0, 6/8 patients had severe disease when they presented to the hospital . 4/8 responded well to treatment and 4/8 does not responded . Topical 1% cyclosporine A was used in 2 patients . Both the patients do not improve in the study period . 5 patients in this study were treated with systemic antihistaminic . 4/5 patients were feeling symptomatically better . One patient who was refractory to steroid eye drops was treated with 0 . 03% tacrolimus eye responded well . Mechanical resection of giant papillae was done in one patient and but patient had recurrence after 2months . Later treated with cyclosporine an eye drops and responded for the therapy . CONCLUSION: The treatment of choice for mild to moderate VKC is a dual acting topical ocular medication (M ats cell stabilizing with antihistamine effect) . Mild steroids in mild to moderate cases and potent steroids in severe cases help in rapid relief of symptoms, but should be used with caution . Preventive measures like avoidance of allergen, cold compression provides symptomatic relief . Artificial tear substitutes provide a barrier function and help to improve the first – line defense at the level of conjunctival mucosa . Systemic and or topical antihistamines may be given to relieve acute symptoms . Immuno modulators are helpful in refractory cases .
Databáze: OpenAIRE
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